Tomoko Nakagami, Yayoi Yamamoto, Sayaka Fukushima, Junko Oya, Yasuhiko Iwamoto and Yasuko Uchigata
Aims: Cholesterol absorption is reported as an independent risk factor for cardiovascular disease. However, factors related to cholesterol absorption have not been fully examined in patients with type-2 diabetes (T2DM). The aim of this study was to assess cholesterol absorption/synthesis markers and the effect of an inhibitor of cholesterol absorption, ezetimibe, in patients with T2DM with hyper-low-density lipoprotein cholesterolemia. Methods: We included 59 patients treated with statins (S group) and 121 patients who were not receiving any Lipid lowering treatments (N group). Levels of cholesterol absorption and synthesis markers were compared between the 2 groups and between subjects in the N group with and without microvascular complications. The lipid-lowering effect of ezetimibe treatment (10 mg/day for 12 weeks) was examined in 70 patients with high levels of low-density lipoproteincholesterol (LDL-C). These patients were divided into the monotherapy (M) group (n=57; ezetimibe treatment only) and the combination therapy (C) group (n=13; ezetimibe and statin treatment). Results: The levels of cholesterol absorption and synthesis markers were higher and lower, respectively, in patients in the S group than in the N group (both p<0.05). In the N group, the cholesterol-absorption marker levels were higher in patients with microvascular complications than in those without (p<0.05). Ezetimibe decreased total cholesterol and LDL-C levels by 13% and 21% and 11% and 16% in patients in the M group and C group, respectively (all p<0.05). In patients of the M group, ezetimibe decreased the levels of remnant-like particle-cholesterol, high-sensitivity c-reactive protein, and triglycerides (TG; only in cases with TG=150 mg/dL) by 16%, 5%, and 21%, respectively, and increased high-density lipoprotein-cholesterol by 6.8% (all p 0.05). Results: The levels of cholesterol absorption and synthesis markers were higher and lower, respectively, in patients in the S group than in the N group (both p < 0.05). In the N group, the cholesterol-absorption marker levels were higher in patients with microvascular complications than in those without (p < 0.05). Ezetimibe decreased total cholesterol and LDL-C levels by 13% and 21% and 11% and 16% in patients in the M group and C group, respectively (all p < 0.05). In patients of the M group, ezetimibe decreased the levels of remnant-like particle-cholesterol, high-sensitivity c-reactive protein, and triglycerides (TG; only in cases with TG = 150 mg/dL) by 16%, 5%, and 21%, respectively, and increased high-density lipoprotein-cholesterol by 6.8% (all p 0.05). Conclusions: Ezetimibe may be a useful therapeutic option to prevent micro- and macrovascular complications for dyslipidemia in patients with T2DM.